Emergency Medicine Residency Program
Take Home Points –Toxicology
Approach to Poisoned Patients
| |
|Cardiac Arrest – What Treatments May Be Useful? Causative Agents/Antidotes |
|Oxygenation - CN (Cyanide Kit), Methemoglobinemia (Methylene Blue) |
|Bradycardia - CCB/BB (High Dose Insulin/Glucagon/Lipid Emulsion), Organophosphate/Cholinergics (Atropine, Pacing) |
|Arrhythmia - Digoxin (Digi Fab), TCA (Na Bicarb), Local Anesthetics (Lipid Emulsion) |
|Also Consider: Snake/Spider Bites (Antivenom), Balloon Pump, ECMO |
| |
|Modified Resuscitation for Suspected Overdose |
|Airway – Clear obstructed airway, but comatosed/encephalopathy may be reversible |
|( Antidotes |
|Breathing – Provide oxygen, positive pressure as needed |
|Circulation – Most hypotensive patients are not volume depleted but 10-20mg/kg may stabilize blood pressure; if not consider ionotropes (if pump failure) |
|or vasopressor (if vasodilatory shock) depending on offending agent |
|Disability/Dextrose – Consider neurogenic (CVA, ICH, meningitis, Stat Ep) vs metabolic (hypoglycemia, thyroid, uremia, hepatic encephalopathy) as |
|alterative causes of altered mental status |
|( Decontamination |
|Exposure – Treat hypo/hyperthermia (consider NMS, SS, environmental) |
|( Enhanced Elimination |
|Antidotes |
|See Board Review materials for list of antidotes |
|Coma cocktail - DONT (Dextrose, Oxygen, Naloxone, Thiamine), avoid empiric Flumazenil |
|Seizures - Benzodiazepines, consider pyridoxine for isoniazid poisoning |
|Agitation - Benzodiazepines (antipsychotics may cause anti-cholinergic, extra pyramidal, QT prolong effects) |
|Lipid Emulsion – Lipophilic Agents: Local Anestehics, Haldol, TCA, BB, CCB |
|Decontamination |
|GI |
|OG Lavage – only if ................
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